Psoriasis is a chronic skin condition that can impair physical, psychological and social functioning. A sub-population of people living with psoriasis believe that psychological stress exacerbates their physical symptoms. Stress may exacerbate psoriasis via a psychoneuroimmunological pathway. The cortisol awakening response can be used to indicate whether this pathway is functional or dysfunctional. People with psoriasis have an elevated risk of emotional distress (anxiety and depression) and an impaired quality of life. Mindfulness based cognitive therapy has been effective in reducing stress, emotional distress, quality of life impairment as well as improving physical health. The aim of this thesis is to examine the efficacy and acceptability of mindfulness-based intervention for people living with psoriasis and whether the cortisol awakening response mediates the relationship between perceived stress and physical severity of psoriasis. This thesis adopted a mixed-methods design. A pilot, randomised control trial examined the effects of mindfulness based cognitive therapy upon the physical severity, perceived stress, emotional distress, quality of life and cortisol awakening response of people living with psoriasis. These variables were entered into a correlation analysis to examine whether the cortisol awakening response was associated with any of the reported study outcomes (physical severity, perceived stress, emotional distress and quality of life). Completers of the mindfulness intervention were invited to a semi-structured interview to explore the characteristics of the participants who adhered to the intervention and their experiences of participating. The mindfulness intervention significantly improved physical (z=1.96, p=0.05) and quality of life (z=2.30, p=0.02) measurements without changing perceived stress (z=0.07, p=0.94), emotional distress (z=1.60, p=0.12) or cortisol awakening responses (z=-0.33, p=0.74). The overall cortisol awakening response was not associated with physical severity (r=-0.30, p=0.07) or perceived stress (r=-0.20, p=0.25) but was significantly correlated with emotional distress (r=-0.35, p=0.04). The intervention was perceived as an acceptable adjunct treatment option. Participants reported some process barriers that inhibited their learning of mindfulness skills. A profile emerged that described a sub-population of people with psoriasis. This sub-population may be more likely to accept and adhere to mindfulness based cognitive therapy.This thesis provides preliminary support to the concept that increasing mindfulness skill can reduce the physical severity and quality of life impairment in people with psoriasis. It recommends that a fully powered trial be conducted to examine the effectiveness of mindfulness in improving physical and overall functioning for people with psoriasis. This thesis suggests clinicians screen their patients and offer a psychological intervention best suited to their needs and characteristics.

The attainment of ethnic minority students in their host countries has been occupying a significant part of the international literature for many years. However, results suggest that no generalisations can be made on whether an ethnic minority group underachieves in a particular country and the reasons behind their attainment levels, unless that specific group has been investigated in the country in question. Cyprus joined the EU in 2004 and since then the demographic composition in the island changed dramatically; a change reflected in schools. The literature on ethnic minority group attainment in secondary schools in Cyprus is virtually non-existent and, as such, in this PhD programme the aim was to examine the attainment of ethnic minorities compared to native students and the reasons behind the observed patterns. In order to answer the research questions a series of studies were carried out. Initially, two quantitative studies were conducted. These studies used trimester grades as a proxy of attainment and Rasch analysis to turn these ordinal student grades into a linear scale. Descriptive statistics and multiple regression analyses were then run to check for trends and significant associations. Two qualitative studies then followed. Firstly, a focus group study was conducted utilising the help of six young female teachers, all teaching classics to create a homogeneous group. Then followed an interview study utilising semi-structured interviews on sixteen teachers. For both studies a thematic analysis was undertaken on the transcribed discussions. Another quantitative study then followed which employed an enhanced methodology to the first two studies and richer data. The final study was a mixed methods study and concentrated on school absences. Results demonstrate the reality in lower secondary schools in Cyprus for the first time. The minority group Georgians, the first time that this group is met in the literature, and a combination of other smaller groups put together in a group called ‘Others’, are shown to achieve significantly lower than natives. Ethnic background, gender, generation status, absences, the socio-economic status of the family and the character of the local educational system were shown to be related to student attainment. The widely held belief that ethnic minority students do even worse in those subjects that are more language-dependent is disproven; rather it is the content of the subject that is felt to be more influential on attainment. Also, the recently emerging consensus that unexcused absences are more strongly associated with attainment than excused absences is not upheld in this study; a more detailed classification of unexcused absences might be responsible for this. Finally, it is interesting to note the differential influence of different absence variables on different school subjects. Findings highlight the need for change and improvement in the educational practice in Cyprus and add to both the local and international literature. The specific factors identified can form the basis on which to base suggestions for improvements and further research.

Research on international students contributes to our understanding of the internationalization of higher education. This study investigates the adjustment of first-year, full-time, postgraduate, international students at a southwestern UK university through a mixed methods research design. The main focus is on reasons for studying abroad, academic experience, and socio-cultural experience. Twenty-six students participated in the qualitative interviews. 250 students responded to a quantitative questionnaire survey. The results indicate that adjustment is a complex set of experiences and many factors may have an impact on it. The data suggest that value of overseas study, personal or family related factors, lack of opportunities at home, and financial or promotional reasons are main motivators driving students to study abroad. Postgraduate international students tend to pay more attention to academic than socio-cultural adjustment because personal agency and cultural identity operate more explicitly in socio-cultural than academic adjustment. Additionally, the data reveal that both acculturation and hybridization account for the processes that inform students’ socio-cultural adjustment. For theories explaining the findings regarding reasons for studying abroad, the push-pull model appears to be more applicable than the Theory of Planned Behavior, whereas Maslow’s Hierarchy of Needs Theory is found to be less relevant because international postgraduate students tend to have special characteristics, which differ from those of host country students, and their satisfaction perceptions regarding different needs are guided by various cultural factors. This study also suggests that the U-curve hypothesis is not supported by the research data, as methodological issues, different internal and external factors, cultural expectations, individual responses or attitudes, and technological and world development have the potential to impact on adjustment. This research adds to theoretical knowledge associated with the adjustment of international students and, in practical terms, increases our current knowledge regarding student recruitment and international student support services.

Risk management in hospitals is an approach intended to improve the quality of services by identifying active and latent factors that put patients at risk of physical and psychological harm when in hospital, and then acting to identify, monitor and control those risks, and effectively manage their impact. The object of this report is to describe important risk management competencies for medical practitioners working in South African hospitals, these practitioners’ current proficiency levels and the competencies with the biggest gaps in practice. The report is intended to present a risk management competency model for medical practitioners working in SA hospitals. This study was conducted in two phases of which Phase 1 was a qualitative research seeking to identify the competencies using literature review and in-depth interviews with medical experts. The second phase was quantitative, characterised by a survey utilising a questionnaire comprising competencies derived from Phase 1. The sample size for Phase 2 was 90 respondents drawn from three population groups and including medical practitioners, professional nurses and members of the hospital management team. The research identified risk management competencies that were later ranked according to their importance using weighted mean averages. A gap analysis was conducted to assess the difference between what practitioners should know and what practitioners actually do in the hospitals in relation to risk management. A new model of “risk management competencies for medical practitioners” has been developed consisting of the knowledge, skills, behaviour and attitude competency domains that have never been previously identified. This model can be used to update certification requirements for independent medical practitioners and professional development programmes for medical practitioners as well as update curricular offerings of the medical schools / Dissertation (MBA)--University of Pretoria, 2014. / zkgibs2015 / Gordon Institute of Business Science (GIBS) / Unrestricted

Research indicates that tobacco cessation rates are at least doubled when smokers receive assistance from a clinician; receiving tobacco cessation advice from multiple types of clinicians increases quit rates even further.¹ To address a decades-long deficiency in the tobacco cessation training of health professionals in general, a shared curriculum, Rx for Change: Clinician-Assisted Tobacco Cessation, was developed in 1999 as a collaboration of the schools of pharmacy in California.^2,3 Between 2003 and 2005, pharmacy faculty members (n=191) participated in national train-the-trainer workshops designed to equip faculty with the necessary knowledge and skills to implement the Rx for Change curriculum at their academic institutions.⁴ <div><br></div><div> The studies that comprise this dissertation are a logical extension of this national initiative, applying a mixed-methods approach to: (a) evaluate the long-term impact of training pharmacy faculty using the Rx for Change program, (b) delineate recommendations for developing and disseminating shared curricula for health-care programs, and (c) evaluate utilization of the Rx for Change website, which hosts faculty resources and curricular files for download. In combination, these (along with a previously-conducted qualitative study) provide a comprehensive “view” of the long-term impact of this unique shared curriculum. </div><div><br></div><div>Results from the three studies provided evidence for: (1) reach to the majority of pharmacy institutions, (2) a high level of adoption of the Rx for Change in health professional schools, (3) a positive impact on faculty trainees’ careers and their level of confidence for teaching, precepting clinical students, and assisting tobacco users, (4) implementation of the Rx for Change curriculum with a variety of teaching methodologies, and (5) continuity of use within the core curriculum of pharmacy institutions. Seven key factors were found to have contributed to the success of the Rx for Change program, and thus the following are recommended for future shared curriculum developers: (1) appeal to attendees, (2) relate content to clinical practice, (3) deliver live training (in-person), (4) develop high quality materials delivered by experts, (5) meet accreditation standards, (6) provide support for teaching, and (7) demonstrate effectiveness. Data from the website analysis provided evidence for interprofessional reach of the Rx for Change website to educators, learners, and professionals.<br></div>

The modern environment of pervasive interconnectedness via mobile devices and services makes it important to understand the nature of customer-bank interactions and relationships. Businesses that offer mobile banking are trying to provide their customers with improved customer service and experiences. The objective of this study is to examine how customer experience of mobile banking influences loyalty towards the bank. This study focuses on the millennials in South Africa. Banks need to remain competitive in the ever-changing business environment. Millennials are one of the largest customer segments with a large digital and mobile appetite; as a result, they form a natural target for banks. To increase their customer base, banks need to ensure that their customer experience strategy caters for these young customers in accordance with their expectations. However, customer experience within mobile banking is under researched. Previous studies in this research area have focused on customer experience in traditional banking context. This study tries to fill the gap by exploring the factors that influence customer experience in mobile banking and also understand how this experience influences customer loyalty to their bank. Considering this, a broad literature review was done that revealed the factors that influence mobile customer experience. Based on literature a conceptual model was developed and this model was used a framework for investigating the research problem. This study used a mixed methods strategy and collected data from 344 mobile banking users via an online survey questionnaire and further, 10 semi-structured interviews were also conducted. The research hypotheses were tested through regression analysis and this resulted in 4 out of 8 research hypotheses being supported. Thematic analysis was used for both the open-ended questions in the survey and the 10 interviews. The results showed that convenience, ease of use and customization are the most significant factors that influence customer experience in mobile banking, whereas the customer experience was in turn found to have a significant influence on customer loyalty. Through conducting this research on millennials in South Africa, this study has expanded the knowledge of mobile banking research in the country. A valuable contribution was made by this study, as this study gave better insight into the factors that significantly influence the customer's experience of millennials in mobile banking. This study recommends that, it is important that banks as well as other firms that offer mobile banking offer a mobile app that is convenient and lets customers to perform their activities in a flexible way in their own time, easily and in a customizable manner. Therefore, should banks implement this study's recommendations it will be beneficial for them as this will result in increased loyalty of their millennial mobile banking customers.

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Farm to School is a program that connects local and regional foods and other farm products to school meals, develops school gardens, and develops other types of Farm to School experiential learning programs for K-12 students. Since Farm to School began in the mid-1990\'s, Farm to School programs have been developed in all 50 states and Washington D.C. The National Farm to School Network has estimated that almost 12,500 schools are involved with Farm to School, and that during the 2011-2012 school year, 5.7 million students were reached through Farm to School programs and activities. Research to date investigating Farm to School has primarily focused on food system and school system stakeholders including school nutrition directors, food distributors, farmers, school teachers, students, and principals. Not as much research has explored Cooperative Extension\'s role in Farm to School. Farm to School programs are one method for Extension professionals to support community food system development while addressing pressing social concerns related to agricultural viability and public health. Drawing on reasoned action theory and social movement theory, the purpose of this study was to explore food system change through an analysis of Cooperative Extension\'s role in the Farm to School movement. In this two-phase explanatory sequential mixed methods research study, the behavioral intentions/behaviors of Cooperative Extension professionals were analyzed. Additionally, the goals, strategies, and knowledge production of Cooperative Extension professionals participating in the Farm to School movement were explored. Data were collected through an online survey distributed to Extension professionals in eight states. A total of 931 Extension professionals completed the questionnaire resulting in a 48 percent response rate. Data were also collected through a state-based case study that explored Ohio State University (OSU) Extension involvement and leadership in the Ohio Farm to School Program. The case study included 21 interviews with OSU Extension professionals and Farm to School program partners. Regression models were developed to explore which behavioral intentions are statistically significant in explaining Extension participation in the Farm to School movement. Results show that past participation in a Farm to School training program, knowledge about Farm to School, attitude towards Farm to School, perceived social norms towards Farm to School, and perceived behavioral control towards Farm to School are positively associated with participation in the Farm to School movement. Drawing on Stevenson, Ruhf, Lezberg, and Clancy (2007), qualitative analysis found that OSU Extension professional\'s goals for the Farm to School movement were primarily related to food system transformation and inclusion, and their strategies were primarily related to connection. Drawing on Eyerman and Jamison (1991), qualitative analysis also found that OSU Extension professionals were producing primarily organizational knowledge through participation in the Farm to School movement. Additionally, qualitative analysis found that Cooperative Extension Systems are home to several Farm to School movement intellectuals. This study concludes with a discussion of recommendations for Cooperative Extension participation in the Farm to School movement, recommendations for Farm to School program partners, and recommendations for future research in Farm to School. / Ph. D.

Up until recent technological developments in neuroscience and advancements in brain imagery techniques, educators and scientists had little insight into what was occurring in the minds of learners. These developments in the field of neuroscience have led to increased knowledge about how the brain develops and learns in childhood. Understanding how music is processed in the brains of young children may provide educators with insights about how to teach more efficiently and effectively, with the potential to either support or refute current classroom practices. Many music educators appear eager to bring strategies with a grounding in neuroscience to their classrooms. It is important then, to understand not only the limits of neuroscientific data and its applicability to classroom settings, but also the degree to which current music teaching practices either correspond or run contrary to current understandings in neuroscience. The purpose of this study is to explore the use of neuroscience recommendations by teachers in elementary general music classrooms; that is, whether current classroom practices correspond with the latest understandings of the developing brain as well as how and to what degree these recommendations for music teaching based on neuroscience are reflected in elementary general music pedagogy.

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